Journal
SCANDINAVIAN JOURNAL OF CLINICAL & LABORATORY INVESTIGATION
Volume 81, Issue 6, Pages 438-445Publisher
TAYLOR & FRANCIS LTD
DOI: 10.1080/00365513.2021.1941235
Keywords
Myocardial infarction; creatinine; cystatin C; glomerular filtration rate; chronic renal insufficiency; shrunken pore syndrome
Categories
Funding
- Vasterbotten County Council
- Norrbotten County Council
- Swedish Research Council [VR 2017-00650]
- Swedish Research Council [2017-00650] Funding Source: Swedish Research Council
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Lower eGFR(cystatin C)/eGFR(creatinine) ratio in women is associated with a higher risk of future MI, suggesting it may be a valuable biomarker for cardiovascular disease risk. Conversely, a high eGFR(creatinine) is independently associated with increased future MI risk in men.
Impaired renal function is associated both with the development of cardiovascular disease and its prognosis. A new syndrome called ' Shrunken Pore Syndrome ' has been suggested, as the estimated glomerular filtration rate for cystatin C (eGFR(cystatin C)) is affected earlier due to differences in molecular size compared to eGFR(creatinine). The aim was to investigate if a lower eGFR(cystatin C)/eGFR(creatinine) ratio in a prospective setting increases the risk of later developing a first-ever myocardial infarction (MI) independently of other cardiovascular risk factors. We used a nested case-referent study design within the Northern Sweden Health and Disease Study, and 545 subjects (29.0% women) were identified who prospectively developed a first-ever MI, and their 1054 matched referents. For women, but not for men, one standard deviation (SD) increase of ln z-scores of eGFR(cystatin C)/eGFR(creatinine) ratio was associated with a lower risk of a future MI: odds ratio [95% confidence interval] 0.58 [0.34-0.99], adjusted for apolipoprotein B/A1 ratio, CRP, homocysteine, systolic blood pressure, body mass index, and diabetes. Furthermore, a high eGFR(creatinine) associated independently with an increased risk of future MI in men only: OR 1.25 [1.05-1.48]. Thus, for women, a lower eGFR(cystatin C)/eGFR(creatinine) ratio is associated with a higher risk of having a future first-ever MI, and it may be a valuable, easily implemented biomarker for risk of cardiovascular disease.
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